Deprescribing in Children: Pediatric Mental Health Minute Series

Deprescribing is the systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within the context of an individual patient’s care goals, current level of functioning, life expectancy, values and preferences.

Scope in Pediatrics

• Among all children aged 6–17 years, 7.5% used psychotropic medication during the past 6 months.

• Use of antipsychotic medications is amongst the fastest growing class of psychiatric medications. Use in Medicaid-enrolled Children age 3-18 grew 62% between 2002 and 2007. Evidence to support this increase for most conditions remains limited.

Teaching Points

• Deprescribing is part of the good prescribing continuum, which spans initiation, dose titration, changing or adding drugs, and switching or ceasing drug therapies.

• Deprescribing is not about denying effective treatment to eligible patients. It is a positive, patient-centered intervention, with inherent uncertainties, and requires shared decision making, informed patient consent, and close monitoring of effects-the same good prescribing principles that apply when drug therapy is initiated.

• Deprescribing considers not only the risk associated with individual drugs but also the cumulative risk from multiple drugs due to pharmacokinetic and pharmacodynamic interactions. (Scott et. al. 2015)

• Deprescribing, like prescribing, starts with a comprehensive psychiatric assessment. This is especially important when a youth is entering the clinician’s care already on medications.

• The diagnosis and knowledge of the course of the disorder should inform the decision of whether and when to taper or discontinue a medication.

• Once the youth is discontinued from those prescribed psychotropic medications which are able to be tapered, the clinician should remain available to the family as needed for support should resumption or intensification of symptoms occur.